Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn
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. Speakers: Dr.Woraman Widab Assist Prof.Olarn Prommalikit Moderator: Prof.Usa Thisyakorn PowerPoint PPT Presentation


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?????????????. Live Vaccine: BCG, OPV, MMR, VZV, OTy, RotaKilled Vaccine: Pertussis, JE, HAV, Rabies Toxoid: Diphtheria, TetanusSubunit (recombinant): HBV, Influenza, aP, HPVPolysaccharide: PS-23, Meningococcal, TyConjugated polysaccharide: Hib, PCV-7 . . ???????????????????????????? ????

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. Speakers: Dr.Woraman Widab Assist Prof.Olarn Prommalikit Moderator: Prof.Usa Thisyakorn

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Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

. Speakers:Dr.Woraman WidabAssist Prof.Olarn Prommalikit Moderator:Prof.Usa Thisyakorn


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

Live Vaccine:BCG, OPV, MMR, VZV, OTy, Rota

Killed Vaccine:Pertussis, JE, HAV, Rabies

Toxoid:Diphtheria, Tetanus

Subunit (recombinant): HBV, Influenza, aP, HPV

Polysaccharide:PS-23, Meningococcal, Ty

Conjugated polysaccharide:Hib, PCV-7


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

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Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

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-


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

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: DTP

8 DTP dT

: DTP 4 4

5

: Hib 2


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

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Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

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-


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

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Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

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1 MMR VZV

OPV, OTy, Rota


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn


Antibody containing products vaccines

Antibody-Containing Products Vaccines


Ab containing products live vaccines

Ab-Containing Products Live Vaccines


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

?


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

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(chronologic age)

- (HBV)

37

2,000

HBV


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

-

HBV 1

-

HBV

1 ( 4 )


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

?


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

-

subcutaneous fat

- adjuvants (aluminum)

local irritation, inflammation,

granuloma formation, abscess, tissue

necrosis


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

- sciatic nerve

- hepatitis B rabies

- BCG


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

Not required aspiration before injection of vaccines


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

HIV


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

HIV HIV

-

: BCG

: OPV IPV

: MMR CD4 < 15%

: Influenza,

Hib, PCV-7, HAV, VZV CD4 > 15%


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

HIV


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

3

> 2 //

2


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

OPV, MMR, VZV, OTy, Rota

- OPV, Rota

- EPI

VZV, Influenza


Vaccination vs steroids

Vaccination VS Steroids


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

anaphylaxis


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

DTaP DTwP ?


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

DTaP DTwP ?

> 3 .

48 .

> 40.5C 48 .

48

.

3


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

DTwP DTaP ?

Encephalopathy 7 ( DT )

Anaphylaxis


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

Non-Expanded Program on Immunization


Scope

SCOPE

Hib

Pneumococcal Conjugate Vaccine

Varicella Vaccine

Rotavirus Vaccine

Hepatitis A Vaccine

Human papilloma virus Vaccine


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

.. 2553


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

.. 2553


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

Haemophilusinfluenzaetype B vaccine (Hib)


Licensed hib vaccine

Licensed Hib Vaccine


Licensed hib vaccine1

Licensed Hib Vaccine


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

-

-


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

3 4 ?


Recommended schedule for doses of hib vaccine

Recommended Schedule for Doses of Hib vaccine

1 7-10


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

PNEUMOCOCCAL CONJUGATE VACCINE


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

?


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

Global PerspectiveVaccine-Preventable Deaths (WHO)

Estimated number of deaths (WHO 2002)

2,000,000

All ages

1,500,000

Children <5 years

1,000,000

500,000

0

Pneumococcal disease

Measles

Rotavirus

Hib

Pertussis

Tetanus

Other*

Meningococcus

Streptococcus pneumoniae is the leading cause of vaccine-preventable deaths globally

*Polio, diphtheria, yellow fever

WHO. 2004 Global Immunization Data. Available at: http://www.who.int/immunization_monitoring/data/GlobalImmunizationData.pdf. Accessed July 11, 2008.


Leading infectious causes of global mortality

Leading Infectious Causes of Global Mortality

<5 years

>5 years

3.5

3.5

3.0

2.7

2.2

2.5

1.7

2.0

Deaths (millions)

1.1

1.5

0.9

1.0

0.5

0

AIDS

Diarrhoea

TB

Malaria

Measles

Pneumonia

S. pneumoniae:

~1.6 million deaths, including ~800,000 child deaths

Source: WHO, 2000 Estimates


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

?


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

Incidence of community-acquired pneumonia in children under 5 years of age in Thailand

Nakhon Phanomcase per 100,000

Sa Kaeocase per 100,000

Hannah T. Jordan, et at. Int J infect Dis. 2009;13:355-361


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

Update Invasive Pneumococcal Disease Burden

in Thailand

The incidence of pneumococcal bacteria cases requiring hospitalization among children aged < 5 years had a range of 10.6 28.9 cases per 100,000 persons(May 2005-June 2007, N=116)

28.9

10.6

Note. Antigen detection only. Patients with alarm-positive blood cultures that failed to grow a pathogen on subculture but had media positive by pneumococcal antigen testing (Binax NOW).

BaggettHC, et al. CID. 2009;48:S65-74


Update invasive pneumococcal disease burden in thailand

Update Invasive Pneumococcal Disease Burden in Thailand

The incidence of IPD in children aged < 5 years per 100,000 persons

The estimates, which are close to estimates of the incidence of hospitalized case of pneumococcal bacteremia in the USA before introduction of PCV

BaggettHC, et al. CID. 2009;48:S65-74


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

?


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

?


Comparison of polysaccharide conjugate vaccines

Comparison of Polysaccharide & Conjugate Vaccines

Pichichero M. Consultant for Pediatricians 2005;June:263-7.


Pneumococcal conjugate vaccines

Pneumococcal Conjugate Vaccines

*Trademark

  • Pneumococcal 7-valent Conjugate Vaccine (Diphtheria CRM197 Protein) Prevnar Package Insert. Wyeth Pharmaceuticals Inc.

  • SYNFLORIX Canada Monograph

  • Kieninger D.M. 48th ICAAC/46th IDSA 2008, Abstr # 2638


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

PCV-7: Serotype Coverage?

50-60 %

60-70 %

70-80 %

80-90 %

100 %


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

Serotype distribution of invasive pneumococcal disease in Thai children under 5 years old(2000-2005, N=115)

Adapted from Phongsamart W, et al. Vaccine. 2007;25:1275-1280.


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

Serotype Causing Invasive Infection In Thai Children < 5 Years Old, 2006-2009Collaborative Study; Siriraj, NIH, Chula, Bhumipol, QSNICH

PCV7 = 70.3%

PCV10 = 70.3%

PCV13 = 81.2%

Sterile sites; n=64

Non-Sterile sites; n=42


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

(effectiveness) ?


Effectiveness of prevenar ipd u s

Effectiveness of PREVENAR*IPD (U.S.)

55

98%

reduction

Rate per 100,000 persons-year

1.2

Adapted form CDC. MMWR. 2008;57:144-148


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

Effectiveness of PREVENAR*All Pneumonia & Pneumococcal Pneumonia (U.S.)

After the introduction of PREVENAR, there was a 39% annual decline in all-cause pneumonia admissionsrepresenting ~41,000 fewer pneumonia admissions in 2004 in children <2 years of age

Adapted from Grijalva CG, et al. Lancet. 2007;369:1179-1186.


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

Effectiveness of PREVNAR*Acute Otitis Media (USA)

Adapted from Zhou F, et al. Pediatrics. 2008;121:253-260.


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

Effectiveness of PREVENAR*IndirectEffectIPD (U.S.)

  • Kellner JD, et al. CMAJ. 2005;173:1149-1151.

  • Poehling KA, et al. JAMA. 2006;295:1668-1674.


Effectiveness of prevnar antibiotic resistant ipd

Effectiveness of PREVNAR*antibiotic-resistant IPD

Adapt from Kyaw MH, N Eng J Med. 2006;354:1455-1463


Children at high risk of invasive pneumococcal infection

Children at High Risk of Invasive Pneumococcal Infection

  • Immunodeficiency : HIV infection, Congenital immune deficiency(excluding CGD), Diseases associated with immunosuppressive therapy or radiation

  • Thalassemia, asplenia or splenic dysfunction

  • Chronic disease

    : Chronic cardiac disease (cyanotic heart and cardiac

    failure)

    : Chronic pulmonary disease

    : Chronic renal insufficiency (including NS)

    : Diabetes mellitus

  • CSF leaks, cochlear implants

PIDST 2010


Recommened schedule for doses of pcv ps23

Recommened Schedule for Doses of PCV& PS23

PIDST 2010


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

Varicella Vaccine


Pidst recommendations for varicella immunization schedule

PIDST Recommendationsfor Varicella Immunization Schedule

2010

  • 1-12 1-2

    - 12-18

    - 2 4 6 (

    2 4 6

    3 )

  • >13 2 1


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

?


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

Breakthrough disease ?


Breakthrough disease

Breakthrough Disease

Breakthrough disease is defined as

a case of infection with wild-type VZV

occurring > 42 days after vaccination

MMWR 2007


Breakthrough disease1

Breakthrough Disease

The median number of skin lesions is commonly < 50

Fewer vesicular lesions (lesions more commonly are atypical, with papules that do not progress to vesicles)

Shorter duration of illness

Lower incidence of fever

Watson BM, et al. Pediatrics 1993:91;17-22.


Breakthrough disease2

Breakthrough Disease

However, approximately 25-30% of breakthrough cases are not mild, with clinical features more similar to those in unvaccinated children

MMWR 2007


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

1 Breakthrough disease 2 ?


Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn

  • RCT compared efficacy of 1 dose & 2 doses vaccines

  • The cumulative rate of breakthrough varicella during a 10-yr

  • was 3.3-fold lower among children who received 2 doses than

  • that among children who received 1 dose

  • (2.2% and 7.3%; p<0.001)

7.3%

3.3-fold reduction rate

2.2%

Kuter B, et al. Pediatr Infect Dis J 2004;23:132-7.


Risk factors for vaccine failure

Risk factors for vaccine failure

Age at vaccination

A retrospective cohort study that adjusted for other potential risk factors demonstrated an increased risk for breakthrough disease for children vaccinated at age < 15 months

(aRR = 1.4; CI = 1.1%-1.9%)

Verstraen T, et al. Pediatrics 2003;112:e98-103.


Risk factors for vaccine failure1

Risk factors for vaccine failure

An increased risk for breakthrough disease

- oral steroids prescription within 3 months before breakthrough disease

(aRR=2.4; CI=1.3%-4.4%)

- varicella vaccine was administered within 28 days of MMR vaccine

(aRR=3.1; CI=1.5%-6.4%)

No association of risk for breakthrough disease with asthma and eczema

Verstraen T, et al. Pediatrics 2003;112:e98-103.


Risk factors for vaccine failure2

Risk factors for vaccine failure

Time since vaccination

Active surveillance data during 1995-2004

Children vaccinated > 5 years previously were 2.6 times more likely to have moderate and severe breakthrough varicella than those vaccinated < 5 years previously (p=0.016)

Chaves SS, et al. N Engl J Med 2007;356:1121-9.


Postexposure prophylaxis

Postexposure prophylaxis

Vaccination within 3 days of exposure to rash was 90% effective in preventing varicella whereas vaccination within 5 days of exposure was approximately 70% effective in preventing varicella

100% effective in modifying severe disease

MMWR 2007


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